Carinal surgery: A single-institution experience spanning 2 decades
Autor: | Michael Lanuti, Ashok Muniappan, Harald C. Ott, Cameron D. Wright, Douglas J. Mathisen, Abraham D. Geller, Christina L. Costantino |
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Rok vydání: | 2018 |
Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty ARDS Blood transfusion Lung Neoplasms Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Anastomosis Risk Assessment law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications law Interquartile range Risk Factors Cardiopulmonary bypass Extracorporeal membrane oxygenation medicine Humans Pneumonectomy Aged Retrospective Studies business.industry Medical record Middle Aged medicine.disease Neoadjuvant Therapy Surgery Trachea Treatment Outcome 030228 respiratory system Chemotherapy Adjuvant Concomitant Female Radiotherapy Adjuvant Tracheal Neoplasms Cardiology and Cardiovascular Medicine business Boston |
Zdroj: | The Journal of thoracic and cardiovascular surgery. 157(5) |
ISSN: | 1097-685X |
Popis: | Objectives Complete resection of neoplasms involving the carina are technically challenging and have high operative morbidity and mortality. This study examines the last 2 decades of clinical experience at our institution. Methods Medical records were retrospectively reviewed between 1997 and 2017 to identify all patients who underwent carinal resection. Primary outcome measures include risk factors for complications and overall survival. Results In total, 45 carinal resections were performed with a median follow-up of 3.4 years (interquartile range 0.8-8.5). Procedures included 21 neocarinal reconstructions (48%), 14 right carinal pneumonectomies (30%), 9 left carinal pneumonectomies (20%), and 1 carinal plus lobar resection (2%). Age ranged from 27 to 74 years, and 23 of 45 patients were female. Eight received neoadjuvant chemotherapy and 6 preoperative radiation. Extracorporeal membrane oxygenation and cardiopulmonary bypass were intraoperatively used for 4 patients with no mortality. Four patients underwent superior vena cava resection and reconstruction. Anastomotic complications occurred in 5 patients, all of which were managed conservatively: 1 required stent placement and a second underwent hyperbaric oxygen therapy. Postoperative events were observed in 26 patients (58%), including pneumonia (n = 11), blood transfusion (n = 8), and atrial arrhythmias (n = 8). More serious complications, such as acute respiratory distress syndrome, occurred in 3 patients. Postoperative events were most closely associated with pulmonary resection (P = .040). There were 3 deaths, yielding an overall operative 30- and 90-day mortality of 6.8% and 7%, respectively. Conclusions Despite advances in perioperative management, carinal resection poses challenges for both patient and surgeon. Preoperative chemotherapy, radiation, and concomitant pulmonary resection were associated with increased risk of complications. Patient selection and meticulous surgical technique contribute to reduction in morbidity and mortality. |
Databáze: | OpenAIRE |
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